Turning an eye on the profession, separating fact from fiction on both sides of the counter

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Weekend Reading

Happy 2014 Everyone! It’s been a while since the last weekend reading update. Here’s some links and posts for your reading pleasure. The picture above is from the Toronto ice storm that we’re still recovering from.

Alternatives to Medicine

Naturopathic medicine, despite its claims to the contrary, is not evidence-based. Given this reality, provincial health ministries need to carefully consider the long-term implications — including the legal and ethical challenges — of formally legitimizing the pseudo-scientific. If naturopathic medicine were governed by science, as practitioners increasingly claim, they would not provide: detoxification services, homeopathic remedies, most herbal remedies, and cosmetic facial acupuncture. But these types of services are the core of naturopathic medicine.If you don’t believe me, I invite you to Google “detoxification and naturopath.” You will get a list of clinics offering things like colon cleanses (useless, potentially harmful, and a bit disgusting), ionic foot baths that create an “energy field similar to that found in the human body” (so scientifically ridiculous that it borders on parody), and infrared sauna therapy (ditto).

In many ways, the supplement business is the 21st century incarnation of the elixir purveyors of bygone eras. In the 19th century, a snake oil salesman might peddle his wares by capitalizing on people’s ignorance of medicine. Today’s supplement industry capitalizes on their suspicion of it.

Should homeopathy be a self-regulating profession? Why not unicorn tamers and flying carpet manufacturers then? From the Kingston Whig-Standard, Professor Udo Schuklenk, The Rise of Humbug Medicine, which is excellent throughout:

Meanwhile in Ontario the association of naturopaths is lobbying the provincial government to regulate them as if they were a body made of professionals. They even lobby for the right to prescribe medication. For an organisation that’s representing a body of ‘practitioners’ who are overwhelmingly deeply skeptical of mainstream science and who consider the gold standard of clinical research, namely randomised controlled clinical trials, not very useful, that’s a bit rich. If you go to any of their ‘homemade’ colleges (they call themselves accredited but their accreditation is really by a body made up of colleges like themselves) you will come across a hell of a lot of unscientific nonsense. The principal idea here is a naive trust in nature’s ability to heal our disease-afflicted bodies. We are supposed to trust in our body’s ability to heal itself.

But the Food and Drug Administration doesn’t regulate dietary supplements as drugs — they aren’t tested for safety and efficacy before they’re sold. Many aren’t made according to minimal standards of manufacturing (the F.D.A. has even found some of the facilities where supplements are made to be contaminated with rodent feces and urine). And many are mislabeled, accidentally or intentionally. They often aren’t what they say they are. For example:

In 2003, researchers tested “ayurvedic” remedies from health food stores throughout Boston. They found that 20 percent contained potentially harmful levels of lead, mercury or arsenic.

In 2008, two products were pulled off the market because they were found to contain around 200 times more selenium (an element that some believe can help prevent cancer) than their labels said. People who ingested these products developed hair loss, muscle cramps, diarrhea, joint pain, fatigue and blisters.

Last summer, vitamins and minerals made by Purity First Health Products in Farmingdale, N.Y., were found to contain two powerful anabolic steroids. Some of the women who took them developed masculinizing symptoms like lower voices and fewer menstrual periods.

Last month, researchers in Ontario found that popular herbal products like those labeled St. John’s wort and ginkgo biloba often contained completely different herbs or contaminants, some of which could be quite dangerous.

The F.D.A. estimates that approximately 50,000 adverse reactions to dietary supplements occur every year. And yet few consumers know this.

Pharmacy Practice

Honoring a pledge made in 2011, drug makers have added restrictors to infants’ and children’s acetaminophen, the active ingredient in Tylenol. That year, roughly one-quarter of kids’ ER visits for drug accidents involved pediatric or adult formulations of acetaminophen. But the industry has neither promised nor delivered such protection on other medicines, which account for more than half of kids’ ER visits stemming from drug accidents, including antihistamines, ibuprofen, and cough and cold preparations. ProPublica purchased more than 50 pediatric versions of these products marketed by nine different brands at outlets in California, New York and Washington, D.C., this month. None of the products we bought had flow restrictors.

The teenager didn’t have her ‘epipen’ injection device, often carried by people with allergies, with her. Her mother told how she went around the corner to Hamilton Long chemist on O’Connell Street and desperately asked for an epipen injection to bring to her daughter outside. “He told me I couldn’t get it without a prescription. He told me to bring her to A&E.”

Pharmacists’ education should include skills to enable critical evaluation of health products and ability to explain why homeopathic products have no medicinal justification. The risk to professional credibility of selling these products is strong and most pharmacists do not endorse their value. Removal from pharmacies is unlikely to impact upon financial sustainability. There is a compelling argument for an urgent change to practice in this area.

Vaccines

The Internet is filled with quack pseudo-science, insisting the flu vaccine is dangerous or ineffective, a Big Pharma conspiracy. When health workers refuse vaccination, it feeds the paranoia, suggesting immunization must be dangerous after all.

Diets and Nutrition

The recurring formula is apparent: Tell readers it’s not their fault. Blame an agency; typically the pharmaceutical industry or U.S. government, but also possibly the medical establishment. Alluding to the conspiracy vaguely will suffice. Offer a simple solution. Cite science and mainstream research when applicable; demonize it when it is not.

So where does aspartame’s bad reputation come from? Largely from a lack of understanding (and sometimes willful misrepresentation) of chemistry.First and foremost, there is the naturalistic fallacy, the common belief that what is “natural” is inherently good, and that anything man-made is inherently bad. Practically, that leads us to think that “natural” substances like sugar are always better than “chemicals” like aspartame. We tend to forget that all foodstuffs have chemical components, whether they are fruits or artificial sweeteners.

This conflation of newsiness with news, share-worthiness with importance, has wreaked havoc on the media’s skepticism immune systems. It didn’t happen out of nowhere, it’s a process that’s been midwifed by the willful blurring of the lines between fact and fiction on the part of a key group of influential sites, that have, unfortunately, established a viable financial model amid the wreckage of traditional media.

2 thoughts on “Weekend Reading”

The risk to professional credibility of selling these products is strong and most pharmacists do not endorse their value. Removal from pharmacies is unlikely to impact upon financial sustainability.

But what if it sets a precedent?

What if people then expected Australian pharmacies to remove all products with no evidence base from their shelves?

No more supplements. No more unproved (or disproved) arthritis treatments. No more fad diet programs. No more quack medical devices.

What if things got completely out of control and pharmacists stopped doing inappropriate and potentially harmful promotions, such as the carry bag giveaway a local pharmacist was recently offering those who purchased multiple packets of a bowel paralysing anti-diarrhea medication?

What if doctors got into the act and stopped sending patients to pharmacies armed with antibiotic prescriptions for colds and SSRI prescriptions for almost everything?

The Australian pharmacy industry would be brought to it’s knees if it was only allowed to sell products that might actually help it’s customers.

One comment I would like to make (which would also be for Science based medicine and Dr. Crislip) :
As I had to work on the subject of Homeopathic preparation, I had a small chat with one of my colleague who happens to have studied pharmacy. It is really important to understand that homeopathic preparation DO NOT NEED to be diluted. The dilution is just there for “potentiating” but many many preparation are only D4, some are even sold as TM (undiluted). This is important as it means that you have peoples ingesting almost every known substances for almost every known diseases. Guess what : it becomes statistically possible that one or two of those are indeed useful (and many more quite toxic). Per chance, most commercially available homeopathic remedies are just water, but don’t dismiss Homeopathy based on dilution, as it is not essential.
If you want to see how much different products are “registered”, here are some examples found with a quick google search :